He is a leading figure in neurosurgery in Timisoara, but not only, being very recently elected president of the Romanian Society of Neurosurgery. He is the doctor due to which, in Timişoara, more than 20 years ago, two types of operations were performed for the first time, interventions that are now routine. In the 36 years since he first put the scalpel on a patient, he has seen thousands and thousands of brains, and yet there are still situations that excite him in the operating room.
I invited the primary neurosurgeon Horia Pleş, the head of the Neurosurgery Department of the County Hospital from Timişoara, to a dialogue. About this profession, the most difficult specialization in medicine, which he practices with passion and which, he says, he will be interested until the last moment. About the sensation he has entering the labyrinth of a man’s thoughts. About surgeries in which miracles happened – ” I think sometimes there has to be something above me and the patient ,” says the neurosurgeon. About empathy with patients and the emotional charge they take from them. About unanswered questions about brain activity.
Ten years ago he made a calculation: I had seen about 10,000 brains” Mr. Horia Pleş, why neurosurgery?
I was a student in the first year – the period when the preclinical subjects are taught, quite boring (anatomy, physiology, pathological anatomy, biochemistry) – I was assigned, two or three weeks, each according to the knowledge I had in the group, to a hospital, in practice. Those who had colleagues with medical knowledge in the group went to the General and Internal Surgery departments. Our group – which included Dr. Vâlceanu, who became a professor of surgery at the County Hospital – arrived at Neurosurgery. At that time, neurosurgery was not well known and it was said that those in this specialization had nothing to teach anyone anyway. At one point, I was at the County Hospital and I heard the anesthetist say, “The thugs are coming.“I did not know who they were. And a belly appears, then an unshaven face – it was Dr. Miclăuş, the head of the Neurosurgery Department at the time. After him, another belly and another unshaven face: Dr. Borzan, the future department head. The third belly and unshaven face was Dr. Hess’s. That’s how I got to the “scandals”, but I really liked it. I was impressed by Dr. Miclaus, a true scientist. Coming from Bucharest, as a lecturer, the management of the University of Medicine and Pharmacy in Timişoara took his classes in the discipline of Neurosurgery, leaving him as a lecturer without students.
Professionals for over 30 years…
Yes, 36. In neurosurgery, I first put the scalpel on the patient in 1982.
About how many operations have you done so far?
I don’t know exactly, but at one point, during an interview, I was asked to say how many brains I saw, and then I did a calculation, and at that point, I saw about 10,000. That was about ten years ago. My then-boss made a little fuss about me, calling me ” the man who saw 10,000 brains .”
How does a neurosurgeon maintain the suppleness and agility of his fingers?
I don’t maintain it in a certain way, but I know that there are doctors in history who, for example, worked tapestry. Then I met a teacher from Romania, whom I saw, at the beginning of autumn, getting off the plane and wearing fur winter gloves. I asked him why he was wearing them and he told me that his hands were very precious and that nothing should happen to him.
In my youth I practiced experimental surgery and operated on one rat a week. I cut the aorta of a rat, which is a millimeter in diameter, sewed it and remade it under a microscope – the thread with which it is sewn is not even visible to the naked eye. It is a very painstaking job and must be functional, that is, after waking the rat, it must not be paralyzed or die. These were, early in the career, microsurgery exercises. Now, since I operate on the operating microscope almost every day, I don’t train in particular.
“We neurosurgeons have a certain gentleness in touching the brain”
Do you remember how you felt when you first saw a brain, when you entered that labyrinth of thoughts, of a man’s conscience?
Maybe at first it’s a special feeling, you’re scared that you can touch a person’s brain, knowing that there are so many networks of thoughts, calculations that, if you’re not careful, you can destroy them. But in the end, we do a job.
We, the neurosurgeons, behave differently from the rest of the surgeons, we have other gestures during the operation. They, for example, open a patient’s abdomen and can control all organs by hand. We open the target – for example, in the case of trigeminal neuralgia, which we operated on yesterday, a two- or three-centimeter hole is made, with the operating microscope magnifying 10-20 times – and the movements are extraordinarily fine. , the elbows do not move at all, so that we can, through that small hole, enter 10-12 centimeters deep in the brain and perform the operation. We have a certain gentleness in touching the brain.
After an operation on the brain, the patient’s memory, intellect, reason itself may be affected…
Of course, yes, although there are approaches, ie the places where you enter the brain, so as not to damage the eloquent areas, ie areas that lead to consequences such as paralysis, motor deficits or speech disorders. There are, for example, areas of the brain that, if touched, the patient can no longer do mathematical calculations or forget what he did a few hours ago. So, they can be very serious and irreversible cognitive impairments.
Are there situations in which, after the intervention, the nerves recover in different connections?
Something similar exists in recovery. If the patient is paralyzed on one side, the recuperator works that hand, so that ankylosis does not appear, but he also works with the healthy part, somehow in the mirror, to learn the paralyzed hand as well. If you move part of the motor area, the area that makes your hand or foot move, within a year, two areas of the motor area move a little elsewhere. That means brain plasticity. And then you can reoperate the operator and remove the rest of the tumor that could not be removed at first, because the patient would have been paralyzed.
“I’m especially excited about the kids in the operating room”
Did you face situations in which you decided to operate on a man, even though the chances were zero, and yet in the minutes, in those hours, miracles occurred and you turned him away?
Yes, and not infrequently. I remember a patient with a very complicated tumor, whom I saw many years ago, and to whom I told that no one could operate on him in Romania and that it would be good to go abroad. He arrived in the United States and was told that the intervention was very dangerous. He then went to France, where he was also refused. He returned to Bucharest, where he was told that the surgical and anesthetic risk was huge and that no one was operating on him. After about two years, it still came to me. He could no longer move his hands and feet and could no longer breathe on his own. Although the operation was extremely risky, I decided to give him the only chance he had. But when I operated on him, my responsibility was no longer so great, it was clear that without intervention, he would be gone in the next few weeks. I operated on him and he went home on his own two feet. And now he lives relatively normally.
Do you attribute the success of a surgery with insignificant chances strictly to the science, to the professionalism of the surgeon or do you think that sometimes it is also a divine intervention? Are you a believer?
I am faithful, but not clumsy. I think sometimes there has to be something above us, me and the patient. Because I can’t explain how a very difficult case suddenly goes well, and a case with which you didn’t have any intraoperative problems degenerates.
Are you still excited about the operating room?
Yes, especially children. Although, after decades, nothing should move me. And now I’m wondering if I did what I did well, if I could do better next time.
How many children did you operate on?
Personally, not many. But we at Neurosurgery operate on about 80-100 children a year.
Do you have any patients who are still in touch with you?
Yes, many. The patient comes to neurosurgery sometimes in a very serious condition, unconscious, or goes home with retrograde amnesia, meaning he forgets what happened in the hospital. Some come to me after a few months or a few years. I was recently visited by a lady, whom I operated on for a cerebral aneurysm, and who told me that she had only come to know me, to see who had saved her life, because she had only known me by name.
“Patient empathy, taken to the extreme, is not good in our cases”
Do you take the emotional charge from the patients or do you manage to detach yourself from their problems, from their suffering?
At the hospital, you charge negatively, that’s clear. However, I feel much more relaxed when I come out of a successful long operation than when I am not in surgery that day and do a lot of small administrative tasks.
Going back to what you asked me, in most cases I manage to detach myself. I think that extreme empathy is not good in our cases. As a doctor, I have to detach myself so I can do what needs to be done.
How do you do it by self-suggestion or is it already routine?
Through education I succeeded. Now, yes, it’s routine.
“When the anesthetist calls to let you know that the patient is well, you feel like flying.”
What was the longest operation?
The time of operations is also shortened according to experience. If at the beginning of the career the operations were very long, now they are much shorter. For example, if in 1995, when I introduced operations for a cerebral aneurysm in Timişoara, I had such an operation in nine hours, now I operate in 90 minutes.
The longest operation lasted 19 hours, but I did not operate alone, nonstop. I left the hospital around 3:00 in the morning. The patient woke up later, and around noon they informed me that he was in a coma again and I operated on him for another four hours. So 23 hours.
How do you feel when the patient opens his eyes? Do you still have emotions?
Sure you do. If after two or three hours the anesthetist calls to let you know that he has unburdened the patient and that he is OK, you feel like flying. It is the euphoria of the moment. If the patient opens his eyes, if he smiles it matters to a neurosurgeon. If he can talk, you know he’ll be fine. If, however, you realize that it was useless after the operation, you feel that you have lead legs, you can barely climb the floor from the operating room.
“I try to detach myself, but I don’t always succeed”
Are you leaving home with problems from the hospital, where you meet another neurosurgeon ( his wife, Stanca Pleş, is the only female neurosurgeon in Timişoara – na)?
Not. I try to detach myself, although I don’t always succeed completely. Sometimes I can’t help but wonder why something is wrong, other times I dream of the patient at night – there is a subconscious that works. But still, when I get home, I try to think of something else, not get overwhelmed by the hospital activity. In the medical world, the highest suicide rate is among surgeons. Because of the pressure under which he works.
What are the moments of respite? How do you get back on track?
If you go fishing and you’re still thinking about neurosurgery, you haven’t done anything. I look at Mezzo more recently when I get home. I really like ballet, and lately I’ve found that symphonic music is much calmer than other genres, and I’m really happy to listen to it. If I go out, I go to my parents’ house in the country, although I’ve been getting there less and less lately. I look at the hills, nature and I recover, I seem to absorb energy from there.
“If computer networks store so much information in the air, the brain’s information may be stuck somewhere.”
After so many years of routine surgery, are there any questions about the brain that you, as a neurosurgeon, are asking yourself that you can’t answer?
These are questions that have to do with philosophy, with research. We neurosurgeons are so caught up in the “trivial” daily practice that we don’t have time to think about it.
Fifty years ago, the doctor was also an intellectual and was part of the cultural elite of a community, because he went to the theater, read a lot of books, and poetry, and prose, visited painting exhibitions. Right now, there’s not much time for that. This stack of office papers is here because I didn’t get to read it. And they’re all about medicine…
You’re interviewing me at an age when, after 36 years of neurosurgery, I shouldn’t care about medicine anymore. I want it, I don’t want it, the pension is approaching. Tennessee Williams said there was a time when you had to leave, even if you didn’t have a clear place to go. And yet if there is anything about neurosurgery that seems new to me, I read, I go deeper. I’m going to be interested in neurosurgery until the last minute.
Do you think there is anything left, somewhere, from this huge base of information, memories, thoughts that is the brain, after the death of the body?
There is much emphasis on the theory of the existence of parallel worlds; then this information should go somewhere else. After all, if computer networks store so much information in the air, the brain’s information might stay somewhere, but that’s kind of SF, right now. Answering the question with your feet on the ground, I would say that there is nothing left of us after death.
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